Hot Topic: Early Potty Training

What's the perfect age to potty train? Two experts give two very different answers. Read them over and see what you think!Plus:Potty Training BasicsGear to Help you Potty TrainBest Potty Training BooksTop 10 Potties

What's the perfect age to potty train? Two experts give two very different answers. Read them over and see what you think!Plus:Potty Training BasicsGear to Help you Potty TrainBest Potty Training BooksTop 10 Potties

Baby Can Go Diaper-Free from BirthSarah Buckley, MD

Training Too Early Causes ProblemsSteve J. Hodges, MD

Elimination Communication (EC) is a way to teach your child to use the toilet starting in infancy. It’s very different from potty training and has many advantages. With EC we train ourselves to use the baby's innate system for elimination -- if you think about it, no baby animal soils the nest! -- rather than train the child.

The number one cause of complication and disorders I see in my clinic -- this includes dysfunctional elimination, bedtime wetting, urinary incontinence, urinary frequency and urgency, and urinary tract infections (UTIs) -- are caused by kids not going to the bathroom on time. Not only that, the vast majority of kids who come in with one of those urinary symptoms also has some component of constipation, caused by a “backup” of not going often enough. My belief is that you can’t trust a kid to go to the bathroom on time, and they have less understanding of when they need to go the younger they are.

Start Before Six Months and Finish By Two

EC is most effective if begun in the first six months, and can be started with newborns. Some people have begun later than six months , but it may be more difficult. This is because all babies signal their need to eliminate (cry when they’re uncomfortable and need to pee or poop) and if we don't respond to their communication over many months, they eventually give up signaling. If you start this practice after a few months, it can seem like your baby is very relieved (pun intended!) that you are finally getting what they have been telling you for so long! With EC, most children will become independent in their elimination during the second year, depending on their dexterity with clothing and the potty.

Three Tends to Be the Best Age

I can’t say there’s a perfect age to potty train. But I don’t know any kids under three that are capable of making good decisions. Your child should show readiness before they potty train -- whenever they can dress and undress themselves, can communicate with you need to go to bathroom, and have the dexterity and body control to do that. They also need the maturity to understand that they need to respond to body urges. There’s no guarantee that three-year-old can do that, but they’re more likely to than a two-year-old.

It’s a Way to Build a Bond

When we begin to pick up their cues and respond, we develop a "language" with our baby, such that we both understand what is happening around elimination. EC could look like this: a few minutes after baby has been fed, they begin to squirm or make a face. They may begin to strain. Then, we hold the baby over a small potty or tub. We signal in some way, maybe with a noise or a hand signal or the position we hold them in. They have communicated their need to eliminate, and we have communicated that now is the place and time to eliminate.

EC Doesn’t Always Work

I’m not a big fan of Elimination Communication. I think it can work in some kids, but countries where it’s predominantly used are different from America. There’s different access to restrooms and a different diet, with less constipation. If your child never got constipated, then it would never be an issue. The problem with constipation is, it’s hard to predict. Kids need to go to the bathroom on time. And the more responsibility on them, the worse it is. I’ve also heard of potty pauses -- which are basically when EC is botched. It doesn’t always work.

EC Saves Time, Money and the Environment

I recommend EC because it saves so much time, washing and expense, and because it’s fun. You do need to be present and attentive to your baby, or have a caregiver who can be attentive. It also prevents diaper rash, and I think it much more pleasant for the child than spending years in soiled diapers. You don't even need to do it full-time! Many parents just catch those easy-to-guess poops or the first-waking pees, saving themselves several diapers per day. I am not critical of conventional potty training, but I encourage parents to look at EC as an alternative, and to try it out!

Toilet Training Stops Bladder Growth

Do you know how many UTIs I see in anatomically correct children before potty training? None. How many after potty training? Enough to buy a house. It’s a big difference. Uninhibited voiding -- meaning, letting them go in a diaper -- is so much more healthy than giving two-year-old the responsibility to stop what they’re doing and go to bathroom. You know how people who go to the bathroom often say they have a “small bladder?” The bladder grows from birth until potty training -- not a specific age. Uninhibited voiding is helpful to bladder growth.

Sarah Buckley, MD, is a family physician, mother of four, and author of Gentle Birth, Gentle Mothering.